Discretionary Leave Form - Executive Office Shared Environment

Preparer Name(Required)

Your name

First Last

Preparer UW Email(Required)

Your UW email address

Alternate Contact

In the event of your absence, who should be contacted?

First Last

Alternate Contact UW Email

Alternate contact's UW email address

EO Assistance(Required)

Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form?

No

Yes

Team Member Name

First Last

Employee Name(Required)

First Last

Employee UW Email(Required)

UW email

Employee Unit(Required)

AP Sub-Units(Required)

ASA Sub-Units(Required)

DCCS Sub-Units(Required)

HSS Sub-Units(Required)

PRES Sub-Units(Required)

Effective Date(Required)

Effective date of discretionary leave allocation.

Number of Days

Maximum of six (6) days per calendar year.

Please enter a number from 1 to 6.

Formal Notice Documentation Upload(Required)

Upload formal notice to recipient of discretionary leave.

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.

File Upload

Upload any other documentation that would be helpful to the EOHR team when reviewing this request.

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.

Additional Information

Provide any additional, relevant information on needed action.